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(Circulation. 2003;108:1208.)
© 2003 American Heart Association, Inc.

Clinical Investigation and Reports

Direct Imaging of Exercise-Induced Myocardial Ischemia With Fluorine-18–Labeled Deoxyglucose and Tc-99m-Sestamibi in Coronary Artery Disease

Zuo-Xiang He, MD; Rong-Fang Shi, MD; Yong-Jian Wu, MD; Yue-Qin Tian, MD; Xiu-Jie Liu, MD; Shi-Wen Wang, MD; Rui Shen, MD; Xue-Wen Qin, MD; Run-Lin Gao, MD; Jagat Narula, MD; Diwakar Jain, MD, FRCP

From the Cardiovascular Institute and Fu Wai Hospital, Chinese Academy of Medical Sciences (Z.-X.H., R.-F.S., Y.-J.W., Y.-Q.T., X.-J.L., X.-W.Q., R.-L.G.), Institute of Geriatric Cardiology, General Hospital of Chinese PLA (S.-W.W., R.S.), Beijing, China, and Drexel University College of Medicine (J.N., D.J.), Philadelphia, Pa.

Correspondence to Diwakar Jain, MD, FRCP, Professor of Medicine and Director of Nuclear Cardiology Laboratory, MS #470, Drexel University College of Medicine, 245 N 15th St, Philadelphia, PA 19102. E-mail Diwakar.Jain{at}drexel.edu

Received December 9, 2002; de novo received March 31, 2003; revision received June 18, 2003; accepted June 19, 2003.

Background— Scintigraphic myocardial perfusion imaging is the most widely used noninvasive modality for the detection of coronary artery disease (CAD). A technique for direct imaging of exercise-induced myocardial ischemia is highly desirable and preferable over perfusion imaging but is presently unavailable. We evaluated the feasibility and diagnostic accuracy of direct imaging of exercise-induced myocardial ischemia with fluorine-18-2-deoxyglucose (¹⁸FDG).

Methods and Results— Twenty-six patients with known or suspected CAD and no prior myocardial infarction underwent simultaneous myocardial perfusion and ischemia imaging after the intravenous injection of Tc-99m-sestamibi (^99mTc-sestamibi) and ¹⁸FDG at peak exercise. Rest perfusion imaging was carried out separately. All patients underwent coronary angiography. Exercise ¹⁸FDG myocardial images were compared with exercise-rest ^99mTc-sestamibi images and coronary angiography. Of 22 patients with 50% narrowing of 1 coronary arteries, 18 had perfusion abnormalities (sensitivity 82%) whereas 20 had abnormal myocardial ¹⁸FDG uptake (sensitivity 91%, P=NS). Perfusion abnormalities were seen in myocardial segments corresponding to 25 vascular territories of a total of 51 vessels with 50% luminal narrowing in 22 patients (sensitivity 49%), whereas increased ¹⁸FDG uptake was seen in 34 vascular territories (sensitivity 67%, P=0.008). ¹⁸FDG images were of high quality and easy to interpret but required simultaneous perfusion images for localizing abnormal myocardial ¹⁸FDG uptake.

Conclusions— Exercise-induced myocardial ischemia can be imaged directly with ¹⁸FDG. Combined exercise ¹⁸FDG-^99mTc-sestamibi imaging provides a better assessment of exercise-induced myocardial ischemia compared with exercise-rest perfusion imaging. Direct ischemia imaging eliminates some of the limitations of presently used myocardial perfusion imaging. Large-scale clinical studies are warranted.

Key Words: myocardium • ischemia • coronary artery disease • exercise • imaging

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